Many clinicians and researchers advocate for abandoning the term “suicide gesture,” but its use still persists. Over the last few years, several definitions have been reported:
“…A suicide gesture is like a one person play in which the actor creates a dramatic effect, not by killing or even attempting to kill himself, but by feigning an attempt on his life.”
In another definition of suicide gesture, “a person leads others to believe that he has just made a suicide attempt in order to communicate that he is in distress or to influence the behavior of others in some way.”
Still another definition: “an unusual but not fatal behavior as a cry for help or to get attention, or a suicide gamble, when patients gamble their lives that they will be found in time and that the discoverer will save them.”
What is Wrong with the Term “Suicide Gesture?”
There are several problems with the terms “suicide gesture” and its cousin “suicidal gesture.”
Especially in the clinical world, the terms are sometimes used interchangeably with the term “suicide attempt.” In some clinicians’ eyes, a suicide attempt in itself is a suicide gesture, because the person survived.
Equating a suicide attempt to a “gesture” inherently diminishes the gravity of a suicide attempt. It is dismissive. Pejorative, even. It doesn’t take seriously a person who is experiencing serious pain or other problems.
This is especially true when you consider one of the dictionary definitions of “gesture” at www.oxforddictionaries.com:
“An action performed for show in the knowledge that it will have no effect: I hope the amendment will not be just a gesture.”
So, calling a suicide attempt a “gesture” is just another way of branding someone as manipulative and attention-seeking. After all, their apparent suicide attempt (supposedly) was not an attempt at all, just an action performed for show in the knowledge that it would have no effect.
The dictionary also notes that, in the general sense of the word, “gesture” usually applies to a movement of the head or hands to express an idea or meaning. Even this benign definition suggests that a person who attempts suicide was trying only to convey something to others – not to die.
Misrepresenting Suicide Attempts, Misrepresenting Risk
Calling a suicide attempt a gesture is not only dismissive. It’s also dangerous. The term can mask the true danger of suicidal behavior.
In an article titled “The Problematic Label of Suicide Gesture: Alternatives for Clinical Research and Practice,” Nicole Heilbron and her colleagues note that calling suicidal behavior a “gesture” can understate the person’s suicide risk:
“Labeling of an individual’s behaviors as gestures to family members also may communicate a dismissive stance that may lead to a false sense of security regarding the individual’s safety and needs for monitoring.”
What About “Suicide Attempts” That Are Not Really Suicide Attempts?
Sometimes, a person does something that appears to be a suicide attempt, but without any intent to die by suicide.
Non-suicidal self injury occurs for a great many reasons. Some people hurt themselves without intent to die because it helps them to discharge stress, to penetrate numbness, to punish themselves, or to achieve some other aim such as a rush of endorphins. These are clear cut cases where there is no suicidal intent, and so the act is not a suicide attempt.
Yet it is also true that some people do hurt themselves with the specific goal of actually feigning a suicide attempt for some external gain. Usually people with these feigned attempts have a specific objective in mind, like to get removed from the general population of prisoners in a jail (though a great many people who attempt suicide in jail or prison do so out of a genuine, painful desire to die).
For others, an apparent suicide attempt may actually be a “cry for help,” though it’s important not to dismiss self-harm as manipulative. (I write more about this complex topic here.)
The Reality of Suicidal Behaviors
Sometimes, as I explain in a journal article, we just don’t know whether someone who appears to have attempted suicide really wanted to die. Even people who intend usually have some ambivalence about dying.
Even when people engage in self-harm to cry out for help or effect change in a situation, they are still engaging in dangerous, potentially deadly self harm that goes beyond “just” a gesture. Most individuals have healthy ways of solving problems or receiving attention. Using the appearance of a suicide attempt to effect change represents a dramatic, life-threatening gap in coping skills. The person may not actually be suicidal, but their behavior could still kill them.
Alternatives to the Terms “Suicidal Gesture” and “Suicide Gesture”
There’s no need to use the term “gesture.” When people hurt themselves with at least some intent to die, those are suicide attempts.
When it’s clear that people had no suicidal intent when injuring themselves, then that’s non-suicidal self injury.
If somebody truly and unequivocally fakes a suicide attempt, then the non-suicidal self injury can simply be described with precision rather than labeled. For example: “The client is homeless and sought admission to the psychiatric hospital during the blizzard. When he wasn’t admitted, he pulled out a knife and said he would kill himself unless someone gave him a warm place to stay.”
Whatever the case, there is no need to minimize suicidal behavior by calling it a mere gesture. We make gestures with our hands and head – not with life and death.
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© Copyright 2014 Stacey Freedenthal, PhD, LCSW, All Rights Reserved. Written for www.speakingofsuicide.com. Photos purchased from Fotolia.com.
This was so well written! Thanks so much!
I really enjoyed this article. I lost my son to suicide in 2019 and the terminology surrounding suicide is mind-boggolling in its lack of understanding towards i guess the ‘suicide community’. We did have phrases such as ‘completed suicide’ , uncompleted suicide’ ‘all suicide is avoidable’ (that was a government health promotion), committed suicide, and it’s not until you are in those circles do you realise how incredibly insensitive these words and phrases can be. I am one of many survivors working on changing the wording around suicide. Thank you.
What if my child wrote good by letters to all her friends and family?
Dawn,
Writing goodbye letters is a warning sign that your child is in significant danger of acting on suicidal thoughts. I recommend that you have a frank discussion with them about their suicidal thoughts and that they see a therapist, psychiatrist or other health professional as soon as possible, ideally within hours. You can call the national suicide lifeline for more advice, at 800-273-8255.
Also, these articles might be of interest to you:
10 Things to Say to a Suicidal Person
10 Things Not to Say to a Suicidal Person
10 Reasons Teens Avoid Telling Parents about Suicidal Thoughts
I hope your child gets the help they need and is safe from acting on suicidal thoughts. Thanks for sharing here!
thank you, it’s a good article for me
It can be used to differentiate a good attempt from a poor attempt. A patient who attempts to slit his wrist with a dull butterknife leaving only scratches vs someone who tries with something more lethal. Clinicians need a way to communicate about how high of a risk a patient has for completed suicide.
Patient Zero,
That’s an excellent point, but research shows that a method’s lethality is far less of an indicator of intent to die than the method’s perceived lethality. That is, someone who uses a dull butter knife leaving only scratches might actually be at very high risk if she thought the knife was sharper, thought it would kill her, etc.
Rather than labeling a suicide attempt a “gesture” as a means to communicate level of risk, clinicians can (and should) simply convey their estimate of the person’s level of suicide risk (low, medium, high, imminent). Similarly, they can classify a person’s suicide attempt by lethality, dangerousness, and intent to die (low, medium, high).
Thanks for contributing to the discussion.
Thank you for writing this article. You are absolutely correct, and I hope that more therapists will eventually realize what a damaging phrase this is. My therapist used this term when I told her about a suicide attempt I had made. I had never heard of the term before, but when I looked it up later to clarify what she meant, I realized that it was one of the most insulting things anyone has every said to me. If I was looking for attention, there would be more than two people on this planet to this day who know that I ever tried to kill myself. I stopped seeing her shortly afterwards.